Pediatric and adolescent GERD
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Corresponding author Harland S. Winter, MD Massachusetts General Hospital, Pediatric Gastroenterology and Nutrition, 175 Charles River Plaza, 5th floor, Boston, MA 02114, USA. E-mail: [email protected] Current GERD Reports 2007, 1:171–176 Current Medicine Group LLC ISSN 1934-967X Copyright © 2007 by Current Medicine Group LLC
Gastroesophageal reflux (GER) and GER disease (GERD) are common problems in children and adults. Most infants with GER achieve symptomatic resolution by 1 year of age and are not thought to develop GERD later in life; most adults tolerate intermittent symptoms of heartburn and never develop complications of GERD. Recent data suggest that some children who have persistent GER in infancy may develop symptoms of reflux in preadolescence. Similarly, when symptoms of reflux begin after the age of 2 years, concerns are raised that these symptoms could be early manifestations of GERD later in childhood, adolescence, or as an adult. Identification of children and adolescents with GERD, who may become adults with GERD or experience complications of GERD, is a significant challenge for practitioners. Implementation of safe and effective therapies is essential for not only improving symptoms and quality of life but also preventing longterm complications of GERD in adulthood.
Introduction Gastroesophageal reflux (GER) is defined as the physiologic passage of gastric contents into the esophagus, and GER disease (GERD) in children is defined as the symptoms or pathologic complications resulting from GER [1]. How a clinician determines whether or not a symptom or condition is a complication of reflux remains a central question. For example, when asthma is triggered by reflux, the individual is thought to have GERD-associated asthma. The problem arises in identifying individuals with asthma who have GERD from those with other triggers, such as cold air or environmental allergens. In adults, GERD is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms or complications [2]. The prevalence of GERD has significantly increased between 1982 and 2005 in North America and in Europe but not in Asia, as pointed
out in a recent systemic review by El-Serag [3]. The prevalence of GERD had an average annual increase of 5% in North America and 27% in Europe, whereas the average annual increase was 1% in Asia [3]. In children up to 5 years of age, GERD accounted for the highest proportion of repeat medical visits, and the incidence of GERD and asthma was similar in children ages 7 to 8 years (0.8–0.9 per 1000 patient-years) [4]. Most infants with GER in the first year of life will achieve complete clinical resolution by 15 to 18 months of age [1], but recent reports of long-term follow-up suggest that infants with prolonged GER may be at increased risk to develop GERD in early adolescence [5,6]. Similarly, GER that persists in children beyond 2 years of age may lead to GERD in adults [7,8]. Therefore, recognizing the clinical differences between GER and GERD in children and ado
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